| NPI | 1154985752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN CARLSON Provider General Manager 503-944-9727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251E00000X Home Health |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2022-10-12 |